Evaluation of Hematemesis

Hematemesis means vomiting of blood, due to upper GI bleeding proximal to ligament of Trietz.

Spurious hematemesis-Vomiting of swallowed blood from upper respiratory tract.

Upper GI bleeding 

Etiologically this can be  - Variceal and nonvariceal

Anatomical source of bleeding

1.Oesophagus  

• Varices [10% of UGI bleed]
• Peptic oesophagitis
• Ulcer oesophagus
• Hiatus hernia
• Mallory-Weiss syndrome

2. Stomach

• Gastric ulcer
• Erosive gastritis
• Gastric varices
• Ca stomach
• Polyp
• Leiomyoma
• Congestive gastropathy - Portal HTN
• Angioma
• Hereditary hemorrhagic telangiectasia
• Watermelon stomach - Gastric antral vascular ectasia-[gave syndromel
• Dieulafoys lesion - Mucosal aberrant vessel which bleeds due to pin point defect in mucosa

3. Duodenal 

Duodenal ulcer  (40 % of UGI bleed)

Causes of UGI bleed 

Most common cause of hematemesis

• Duodenal ulcer - 40 percent
• Gastric ulcer - 20 percent
• Erosive gastritis - 20 percent
• Oesophagitis
• Varices - 10 percent
• Mallory Weiss tear

Common causes

•         Carcinoma stomach
•       Bleeding diathesis
•       Leiomyoma

Uncommon causes

•          Angioma - Upper Gastrointestinal cause
•         Hereditary hemorrhagic telangiectasia
•          Watermelon stomach
•          Dieulatoys lesion
•          Hemobilia
•          Ehlers-Danlos syndrome.

Differences Between Hematemesis and Hemoptysis

Hematemesis                                                 Hemoptysis

Nausea, vomiting  precedes                            Cough precedes

Froth - absent                                                  Froth present

PH - acidic                                                      PH - alkaline

Food particles present                                      Absent

Coffe coloured                                                 Bright red

Melaena - present                                             Melaena - absent

H/o Upper Gl disease present                           H/o Upper Gl disease absent